The adenomyosis/endometriosis IVF patient - call for clinical focus.

Fecha de publicación: 25/11/2023 Fecha Ahead of Print: 25/11/2023

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

Alsbjerg B
Humaidan P

Grupos

Endocrinología Reproductiva e Infertilidad

Leader

José Remohí Giménez
Medicina Reproductiva

Investigador Principal

José Morales Roselló

Abstract

Endometriosis and adenomyosis are distinct clinical conditions that carry the same pathophysiological features. In recent years the clinical focus on assisted reproductive technology patients with either condition (E/A) has increased, in the recognition that this subgroup of patients might need special attention to obtain reproductive success. Endometriosis and adenomyosis are characterized by a disruption of progesterone and oestrogen signalling pathways, resulting in local oestrogen dominance and progesterone resistance at the receptor level. Recent scientific evidence suggests that the endometrial progesterone receptor resistance encountered in E/A patients can be overcome by a freeze-all policy, followed by down-regulating circulating oestradiol concentrations prior to frozen embryo transfer (FET), in combination with an increase in exogenous luteal phase progesterone supplementation in hormonal replacement therapy (HRT) FET cycles. Specifically, for adenomyosis patients who do not respond to gonadotrophin-releasing hormone agonist down-regulation in terms of a decrease in circulating oestradiol concentrations, a small case series has suggested that the addition of an aromatase inhibitor for 21 days prior to HRT-FET is a valid option. Endometriosis and adenomyosis are hormonally active diseases, which need to be treated by controlling local hyperoestrogenism and progesterone resistance. Based on physiology and recent preliminary clinical data, the authors of this opinion paper wish to stimulate discussion and spark interest in research in E/A patients.

Datos de la publicación

ISSN/ISSNe:: 1472-6483, 1472-6491
Tipo:: Article
Páginas:: 103737-103737
DOI:: 10.1016/j.rbmo.2023.103737
Factor de Impacto:: 1,171 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Métricas

Filiaciones

Cozzolino M:: IVIRMA Global Research Alliance, IVI Roma, Rome, Italy

Instituto de Investigación. IVIRMA Global Research Alliance, IVI Foundation-IIS la Fe, Valencia, Spain.
Alsbjerg B:: The Fertility Clinic, Skive Regional Hospital, Denmark and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Pellicer A:: IVIRMA Global Research Alliance, IVI Roma, Rome, Italy

Instituto de Investigación. IVIRMA Global Research Alliance, IVI Foundation-IIS la Fe, Valencia, Spain
Garcia-Velasco JA:: IVIRMA Global Research Alliance, IVI, Madrid, Spain

Department of Obstetrics and Gynecology, Universidad Rey Juan Carlos, Madrid, Spain
Humaidan P:: The Fertility Clinic, Skive Regional Hospital, Denmark and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark